Female Collegiate Athletes’ Concussion Characteristics and Recovery Patterns: A Report from the NCAA-DoD CARE Consortium

Concussion has been described in the United States (US) collegiate student–athlete population, but female-specific findings are often underrepresented and underreported. Our study aimed to describe female collegiate student–athletes’ initial injury characteristics and return to activity outcomes following concussion. Female collegiate student–athletes (n = 1393) from 30-US institutions experienced a concussion and completed standardized, multimodal concussion assessments from pre-injury through unrestricted return to play (uRTP) in this prospective, longitudinal cohort study. Initial injury presentation characteristics, assessment, and return to activity outcomes [<48-h (acute), return to learn, initiate return to play (iRTP), uRTP] were collected. We used descriptive statistics to report injury characteristics, return to activity outcomes, and post-injury assessment performance change categorization (worsened, unchanged, improved) based on change score confidence rank criteria across sport contact classifications [contact (n = 661), limited (n = 446), non-contact (n = 286)]. The median (25th to 75th percentile) days to return to learn was 6.0 (3.0–10.0), iRTP was 8.1 (4.8–13.8), and uRTP was 14.8 (9.9–24.0), but varied by contact classification. Across contact levels, the majority experienced worse SCAT total symptom severity (72.8–82.6%), ImPACT reaction time (91.2–92.6%), and BSI-18 total score (45.2–51.8%) acutely relative to baseline, but unchanged BESS total errors (58.0–60.9%), SAC total score (71.5–76.1%), and remaining ImPACT domains (50.6–66.5%). Our findings provide robust estimates of the typical female collegiate student–athlete presentation and recovery trajectory following concussion, with overall similar findings to the limited female collegiate student–athlete literature. Overall varying confidence rank classification was observed acutely. Our findings provide clinically-relevant insights for athletes, clinicians, researchers, and policymakers to inform efforts specific to females experiencing concussion.